This 34 years old afghani worker came to ED with complaint of vague abdominal pain and constipation which were gradually developed in a week.
He didn't have any significant past history or drug history. His V/s was BP:130/90 PR:80 RR:26 OT:36.7 c.
In examination he has a soft abdomen without distension or tenderness, but found out that he has difficulty in walking or sitting. His neurologic examinations were normal except increased tone in all four extremities.
He was admitted in a non monitored ED bed.
About an hour after his first visit, he complained of severe back pain.
This time the examiner noticed that the patient had profound diaphoresis, BP and PR were 180/90 and 57 now.
What do you think? What are your differential diagnoses?
16 comments:
سلام دکتر. خوب چی شد بالاخره دل دردش برا چی بود؟
what do u think?
it can be lots of differential diagnosis. but I reckon, you've found some interesting finding in brain or abdo CT!haven't you?
think about tetanus
Hi, I`m impressed by your care about patient`s privacy.
The problem list of the patient is:
1- Young M/34y Afghan
2- Abdominal pain 3- Constipation
4- difficulty in sitting and walking
4- hypertonicity in extrimities
5- sudden pain,diaphoresis and sudden increase in BP without tachycardia
DDX:
1- Spinal Epidural Abcesss
2- Tetanus
3- Serotonin Syndrome
4- Aortic dissection +- AAA
I'm confused, but I think of some progressive mass, such as an abscess or aneurysm
Maybe a perforated swallowed bag of drugs??!!!
wow, I think these bizarre presentation could be due to med78's last guess!!
but, still your history taking and ph ex is not complete!
What more do u wasnt?
Probably Aortic dissection
maybe TB !
chi shod javab?!
and the answer....??
Patient had tetanus
woooooooooooooowwwwww!Tetanus?It was at the buttom of my differential diagnosis!
Why? no vaccination? any injury or dirty laceration?
Did he die?how did you confirm your diagnosis?!
I didn't know still we have tetanus in Iran!!!
Patient had not any wound in time of arrival but as he was a construction worker it was not out of mind that he had some wounds earlier that healed spontaneously. He didn’t have tetanus vaccination as many other Afghanis didn’t have.
No clinical lab test was developed yet for diagnosis of tetanus and diagnosis is solely based on clinical presentation, history of wound and lack of vaccination.
Tetanus toxoid and immunoglobulin administered for patients and metronidazol started. Patients spasm was treated with IV diazepam and patient transferred to ICU. About one week patient was in ICU and then transferred to ward and then discharged without any sequel.
We had three Tetanus cases last year in our ED, all of them were Afghanis.
and no pathological evidence, just clinical diagnosis?! that's reportable. at least as a case report!
thanks for sharing your experience!
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